title: National trends in the office-based prescription of schedule II opioids.
abstract: OBJECTIVE
  To investigate national trends and patterns in opioid prescription within office-based medical practice.
  
  
  METHODS
  An analysis is presented of 1995-2010 data from the National Ambulatory Medical Care Survey, focusing on overall and stratified trends in the percentage of medical visits involving prescriptions for Schedule II opioids. Among visits with opioid prescriptions in 2003-2010, first-time visits were also compared to return visits, and visits in which pain was the primary complaint were compared to visits with other primary complaints.
  
  
  RESULTS
  Among all office visits, the percentage with an opioid prescription increased from 0.65% in 1995-1998 to 2.63% in 2007-2010 (odds ratio [OR] = 8.01; 95% CI, 4.96-12.94). During the study period (1995-2010), opioid prescriptions significantly increased in visits by male patients (OR = 6.54; 95% CI, 3.21-13.31); female patients (OR = 9.38; 95% CI, 6.70-13.14); and patients aged 18-35 years (OR = 5.82; 95% CI, 2.59-13.10), 36-64 years (OR = 8.30; 95% CI, 4.63-14.86), and ≥ 65 years (OR = 8.85; 95% CI, 6.13-12.77), but not ≤ 17 years (OR = 1.52; 95% CI, 0.50-4.63). Prescriptions for opioids also significantly increased in visits by patients with clinical depression (OR = 9.96; 95% CI, 5.45-18.21) or anxiety (OR = 10.99; 95% CI, 5.02-24.06) diagnoses. However, a significant decline occurred in opioid prescriptions in visits among patients with substance use diagnoses (OR = 0.10; 95% CI, 0.00-3.30). The number of opioid prescriptions rose faster among patients making a first visit (OR = 23.36; 95% CI, 11.82-46.17) versus a return visit (OR = 7.26; 95% CI, 4.38-12.03).
  
  
  CONCLUSIONS
  A substantial increase occurred between 1995 and 2010 in opioid prescriptions in office-based medical visits, especially in visits by middle-aged and older adults and by patients making their first visit to the treating physician. These trends suggest that physicians have pursued greater pain control despite potential risks of nonmedical use of prescription opioids.
authors.affiliation: New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, New York, NY 10032 mo49@columbia.edu.
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
authors.forename: Shuai
authors.initials: S
authors.lastname: Wang
authors.forename: Miren
authors.initials: M
authors.lastname: Iza
authors.forename: Stephen
authors.initials: S
authors.lastname: Crystal
authors.forename: Carlos
authors.initials: C
authors.lastname: Blanco
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004305:Dose-Response Relationship, Drug; D062787:Drug Overdose / Q000401:mortality; D004363:Drug Utilization / Q000639:trends; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000009:adverse effects / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D064226:Prescription Drug Diversion; D063487:Prescription Drug Misuse / Q000639:trends; D055553:Prescription Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D012306:Risk; D014481:United States; D055815:Young Adult
chemical_list: D009294:Narcotics; D055553:Prescription Drugs